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Code requirements with regard to controlling risk factors, such as personal hygiene and temperature control (8). Despite the emphasis that has been placed on the importance of time and temperature control for PHF, significant number of establishments did not comply with the regulation. Food codes in “Control of Hands as a Vehicle of Contamination,” “Protection from Contamination,” and “Food and Non-food Contact Surface Maintenance” categories were also violated by many independent restaurants, both ethnic and non-ethnic. These code violations are related to personal hygiene and crosscontamination, the major causes of foodborne illnesses originating in restaurants (7). Although the researchers did not observe food handling behaviors firsthand in the field, the consistency in the findings from our review of health inspection reports with previously published datasupports the validity of our data. Data from this study could be used to identify food safety training needs for independent restaurants. It is not clear why ethnic restaurants had more food code violations in general and within selected categories than nonethnic restaurants. However, cultural traditions of food preparation handed down through generations may be a contributing factor (12). Poor food handling behaviors, as revealed in this study, could be the source of the greater numbers of foodborne outbreaks associated with ethnic foods (26). Results of this study provide empirical evidence that help justify concerns about the safety of food served in ethnic restaurants. Owners and managers of independent ethnic restaurants need to be more diligent in training their employees about safe food handling. The majority of violations in ethnic and non-ethnic restaurants were considered critical violations, including time and temperature control of PHF, storage temperatures for PHF, and employee hand washing practices. The impact of poor food handling in restaurants is much more serious than in a home setting because of the number of individuals who can be infected with foodborne illnesses. The findings from this study identified areas where food safety training should be focused: time and temperature control; physical facility and food & non-food contact surface maintenance; and control of hands, including hand

washing. The types of frequent violations were not necessarily different from those reported in previously published studies (8, 16, 33). However, differences observed between and among different types of independent ethnic restaurants and non-ethnic restaurants reflected the need for increased food safety training for employees of ethnic restaurants, especially Asian and Mexican or Latin American restaurants. Researchers have addressed the inadequacy of current generalized food safety training with regard to specific food handling of ethnic foods (26). Other researchers have identified barriers to food safety training in restaurants and pointed out that increasing knowledge alone may not improve food handling practices (23). However, no ethnic restaurants were included in the study samples of these researchers (24, 25). Future research should address attitudes toward food safety training, behavioral controls, and barriers to food safety training in ethnic restaurants. Future studies should investigate ways to overcome barriers to food safety training and identify the most cost effective method to train independent ethnic restaurant employees. High employee turnover and lack of resources may be reasons why independent restaurant managers are not enthusiastic about training their employees. However, the cost of having a foodborne illness outbreak attributed to a restaurant is far greater than the cost of training. Food safety educators may need to address tangible and intangible risks associated with foodborne illnesses in order to increase managers’ awareness of the need for training. Another factor to be explored is the role of language barriers in understanding and following proper food safety practices. There were no significant differences in performance between European ethnic restaurants and non-ethnic restaurants, especially for the “Demonstration of Knowledge” category (e.g., identifying person in charge or explaining foodborne disease prevention and application of HACCP). While researchers postulate that language barriers may be a factor in code violations for some ethnic restaurants, there is no evidence to support language barriers being the cause of poor performance in this category. Findings of this study are limited to 14 county regions in Kansas and cannot be generalized to restaurants in other geographic locations. Several other states also

publish health inspection reports online, but the lack of specificity of these reports makes it difficult to compare them with our results. The results are also limited to independent restaurants and therefore cannot be generalized to restaurants operated with franchise agreements or by large corporations, which often exercise internal controls to ensure food safety, with resources available from the parent companies, and which may thus be more likely to perform better than independent restaurants during health inspections.

REFERENCES
1. Akins, D., and A. Simonne. 2009a. Assessing the use of specific cooling practices to prevent Clostridium perfringens growth in refried beans. J. Food Prot. 72(A):84. 2. Akins, D., and A. Simonne. 2009b. Ethnic food safety trends in the United States: CDC foodborne illness data from 1990 to 2006. J. Food Prot. 72(A):165. 3. Barnes, R. 21 January 2005. Turkish restaurant food poisoning outbreak may hit 400. The Sydney Morning Herald [press release]. Available at: http://www.theage.com.au/articles/2005/01/21/1106110931992. html. Assessed 4 October 2006. 4. Center for Science in the Public Interest. Outbreak alert! Database. Available at: http://www.cspinet. org/foodsafety/outbreak/outbrea ksphp?column=pathogen&colval= B.%20cereus. Accessed 1 December 2009. 5. Centers for Disease Control and Prevention. 2009. Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food – 10 states, 2008. Morb. Mortal.Wkly Rep. 58:333–337. 6. Cotterchio, M., J. Gunn, T. Coffill, P. Tormey, and M. A. Barry. 1998. Effect of a manager training program on sanitar y conditions in restaurants. Pub. Health Rep. 113:353–358. 7. Food and Drug Administration report on the occurrence of foodborne illness risk factors in selected institutional foodservice, restaurant, and retail food store facility types. 2004. Food and Drug Administration Web site. Available at http:// www.fda.gov/Food/FoodSafety/ RetailFoodProtection/FoodborneIllnessandRiskFactorReduction/

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http://www.theage.com.au/articles/2005/01/21/11061093992.html http://www.cspinet.org/foodsafety/outbreak_alert.pdf http://www.cspinet.org/foodsafety/outbreak_alert.pdf http://www.cspinet.org/foodsafety/outbreak_alert.pdf http://www.fda.gov/Food/FoodSafety/RetailFoodProtection/FoodborneIllnessandRiskFactorReduction/RetailFoodRiskFactorStudies/ucm089696.htm http://www.fda.gov/Food/FoodSafety/RetailFoodProtection/FoodborneIllnessandRiskFactorReduction/RetailFoodRiskFactorStudies/ucm089696.htm

Food Protection Trends - July 2010

Table of Contents for the Digital Edition of Food Protection Trends - July 2010